title: Smoking and perioperative outcomes.
abstract: BACKGROUND
  Patients are often concerned about the effects of smoking on perioperative risk. However, effective advice may be limited by the paucity of information about smoking and perioperative risk. Thus, our goal was to determine the effect of smoking on 30-day postoperative outcomes in noncardiac surgical patients.
  
  
  METHODS
  We evaluated 635,265 patients from the American College of Surgeons National Surgical Quality Improvement Program database; 520,242 patients met our inclusion criteria. Of these patients, 103,795 were current smokers; 82,304 of the current smokers were propensity matched with 82,304 never-smoker controls. Matched current smokers and never-smokers were compared on major and minor composite morbidity outcomes and respective individual outcomes.
  
  
  RESULTS
  Current smokers were 1.38 (95% CI, 1.11-1.72) times more likely to die than never smokers. Current smokers also had significantly greater odds of pneumonia (odds ratio [OR], 2.09; 95% CI, 1.80-2.43), unplanned intubation (OR, 1.87; 95% CI, 1.58-2.21), and mechanical ventilation (OR, 1.53; 95% CI, 1.31-1.79). Current smokers were significantly more likely to experience a cardiac arrest (OR, 1.57; 95% CI, 1.10-2.25), myocardial infarction (OR, 1.80; 95% CI, 1.11-2.92), and stroke (OR, 1.73; 95% CI, 1.18-2.53). Current smokers also had significantly higher odds of having superficial (OR, 1.30; 95% CI, 1.20-1.42) and deep (OR, 1.42; 95% CI, 1.21-1.68) incisional infections, sepsis (OR, 1.30; 95% CI, 1.15-1.46), organ space infections (OR, 1.38; 95% CI, 1.20-1.60), and septic shock (OR, 1.55; 95% CI, 1.29-1.87).
  
  
  CONCLUSIONS
  Our analysis indicates that smoking is associated with a higher likelihood of 30-day mortality and serious postoperative complications. Quantification of increased likelihood of 30-day mortality and a broad range of serious smoking-related complications may enhance the clinician's ability to motivate smoking cessation in surgical patients.
authors.affiliation: Department of Outcomes Research, The Cleveland Clinic, Cleveland, Ohio 44195, USA. alparslanturan@yahoo.com
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mascha
authors.forename: Dmitry
authors.initials: D
authors.lastname: Roberman
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Turner
authors.forename: Jing
authors.initials: J
authors.lastname: You
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Leif
authors.initials: L
authors.lastname: Saager
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000401:mortality; D014481:United States / Q000453:epidemiology